This article first appeared in the St. Louis Beacon, June 29, 2012 - Top Missouri Republicans swiftly swallowed their shock over losing their Supreme Court fight to kill the Affordable Care Act and have reframed their renewed battle as an attack on a “massive tax increase.”
And the battlefield will be this November’s general election.
“There will be political accountability,’’ asserted Lt. Gov. Peter Kinder in a telephone news conference call during which he called the federal health-care law “the largest tax increase in the history of the United States.”
Fellow state GOP leaders, including U.S. Sen. Roy Blunt and party chairman David Cole, followed suit – with every statementcentering on the word “tax.”
Top Missouri Democrats, however, were generally silent, despite what is seen nationally as a big win for the White House and President Barack Obama. The pro-Democratic web site, Firedupmissouri.com, was the exception -- posting an updated version of the 1948 pictureshowing victorious President Harry S Truman holding up a newspaper with a faulty headline declaring his defeat.
This time, it was a victorious Obama holding up an iPad displaying a faulty CNN headline reporting that the federal health insurance mandate had been struck down.
Gov. Jay Nixon, for example, was markedly noncommittal. “We’re just now beginning to review this ruling so that we can understand exactly what it means for Missouri,” he said in a statement. “This ruling has significant complexities and implications for families, health care providers and insurers in our state.”
The governor has been hammered by Republicans all week over his recently voiced opposition to the Affordable Care Act’s requirement that most Americans must buy health insurance by 2014.
His staff, so far, has not responded to Thursday’s press queries asking what Nixon now plans to do about the state GOP's resistance to setting up health insurance exchanges in the state – as mandated by the act, beginning in 2014 – or the measure’s requirement that Missouri and many other states dramatically expand their Medicaid rolls.
The Supreme Court did curb the federal government’s ability to punish states financially that fail to increase Medicaid eligibility, which may bolster state Republican leaders’ opposition to the idea.
One of Nixon’s campaign issues in 2008 had been his promise to restore the 2005 Medicaid cuts that tossed or trimmed benefits for hundreds of thousands of poor or disabled Missourians. The GOP-controlled General Assembly blocked his early efforts, and the governor hasn’t mentioned the matter in a couple years.
About 850,000 Missourians -- about one-sixth of the state's population -- are believed to lack health insurance, according to the Kaiser Family Foundation, a nonpartisan group that compiles health care statistics.
General Assembly to resist health-care expansion
House Majority Leader Tim Jones, R-Eureka and the new speaker as of January, indicated that his party will oppose any Medicaid expansion. "I know that increasing access to affordable health care is something that needs to be done, but this is the absolute wrong way to do it,” Jones said in a statement, referring to the Affordable Care Act.
“We need to accomplish health-care cost reform the right way -- using a small government, free market-based, capitalist approach to cut the cost of care and ensure more Americans are able to afford insurance," said Jones.
Kirkwood businessman Dave Spence, one of the Republicans challenging Nixon’s re-election bid, declared that the governor “needs to be very clear about his plans in response to the Obamacare decision," said Spence. "Today I'm calling on him to commit to all Missourians that he will not take any action to implement the job-killing law until voters have an opportunity to make their voices heard in November."
Missouri voters will see a ballot proposal this November that would bar any state-created insurance exchange unless such a program is specifically approved by a new state law, or a public vote.
Missouri Attorney General Chris Koster, a Republican-turned-Democrat, did imply in his statement that he may encourage the General Assembly at least set up the insurance exchange, which is intended to make coverage cheaper for Missourians who can’t get insurance through their work.
“The complexity of the decision raises a host of pressing issues for our state, including the need to establish our own health-care exchange, and Missouri’s future options regarding Medicaid expansion,” Koster said. “We will be carefully reviewing the court’s decision in the coming days to determine the best way to protect Missourians, including the decision’s impact on Proposition C, passed in 2010 by more than 70 percent of the vote.”
But efforts to establish an exchange may fall flat.
State Sen. Scott Rupp, R-Wentzville, predicts that Missouri will not set up an insurance exchange. "We made the right decision not to create an insurance exchange," Rupp said. "I don't think Missouri is going to take any steps to create one under the current (legislative) makeup."
His bottom-line message to the federal government? "If you want an exchange, you have to set it up and you'll have to pay for it."
Under fire, McCaskill’s response muted
Meanwhile, Nixon’s measured post-court-decision remarks were still far more expansive than those by a fellow Democrat, U.S. Sen. Claire McCaskill, who is a top national Republican target. She also has caught political fire this week over her decision to skip the Democratic national convention in September in Charlotte, N.C.
Said her spokesman today: "There's only ever been one goal for Claire—affordable, accessible health care for Missouri.” He said nothing more.
Republicans, however, smell political blood. The Republican National Committee asserted, as it has for years, that McCaskill “provided the deciding vote to ram ObamaCare through Congress.”
“The Supreme Court today has affirmed McCaskill’s decision to put President (Barack) Obama’s agenda ahead of Missouri seniors and small businesses,” the RNC continued. “The Supreme Court’s decision makes clear in this election – the only way to stop the massive tax increases, government spending, and cuts to Medicare contained in ObamaCare is to replace liberal Claire McCaskill in Washington.”
George Connor, chairman of the political science department at Missouri State University in Springfield, isn’t surprised by McCaskill’s apparent wariness in the wake of the ruling. But he warns that silence in her case might not be golden.
Connor recalled that McCaskill, more than any other U.S. senator, vigorously confronted the Affordable Care Act’s critics in 2009 – months before its passage – during the summer of discontent that saw combative exchanges around the country.
McCaskill’s chief tactic that summer was to link the act to Medicare, which generally is popular with the public.
“She has to take that tenacity out on the campaign trail again,’’ Connor said. “I understand the motivation to back away. (But) if she backs away too far… then she is going to lose the core Democratic support she needs to win.”
He likened McCaskill’s predicament to the “Robin Carnahan effect’’ that he said plagued that Democratic U.S. Senate nominee in 2010 and contributed to her 14-point loss to Blunt.
Nixon has more “wiggle room,” added Connor, because – unlike McCaskill – he’s not a national Republican target. He has yet to attract the millions of dollars in attack ads that already have aired in the state against McCaskill.
Solid GOP opposition may pose risk
Connor appeared to agree with Blunt, who told reporters Thursday that he believed the Supreme Court decision “probably further energizes people who believe this is a bad idea and we can't afford it.”
Connor said, "The Supreme Court has given (Republicans) a gift" by tossing out the White House's chief defense that the act was allowed under the Constitution's "commerce clause," but letting it stand under Congress' constitutional powers to tax.
"There's a lot of nuance in the phrase 'commerce clause,' " Connor quipped. "There's no nuance in the word 'tax.' "
But Connor added that Republican candidates still face a problem, especially the crowd of Aug. 7 primary contenders for the U.S. Senate and governor.
McCaskill's three chief Republican challengers -- former state Treasurer Sarah Steelman, U.S. Rep. Todd Akin and St. Louis businessman John Brunner -- "are going to beat each other up over who's going to be the most outraged," the professor said.
Their difficulty, he continued, is, “How do these guys differentiate themselves?”
That same dilemma will face Republicans up and down Missouri's ticket, Connor predicted. As an example, he cited Thursday’s spate of dramatic post-decision statements, many of which called the ruling “a moral outrage.”
State Sen. Brad Lager of Savannah, who is challenging Kinder for lieutenant governor, declared that the federal health-care mandates would lead to “the biggest tax increase in the world’s history.”
The problem, said Connor, is that since all the Republican candidates are embracing the same stiff opposition, “it will be harder for primary voters to distinguish between the candidates. They’re all on the same page.”
As a result, Connor predicted that Missouri voters may hear less about Obamacare from Republican contenders leading up to the Aug. 7 primary – and more afterward, when the opponents are Democrats.
Beacon reporter Robert Joiner and Beacon Washington correspondent Robert Koenig contributed to this story.
